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Interview with Dr. Caldwell Esselstyn

INTERVIEW WITH DR. CALDWELL ESSELSTYN

About Dr. Esselstyn:

Caldwell B. Esselstyn, Jr., received his B.A. from Yale University and his M.D. from Western Reserve University. In 1956, pulling the No. 6 oar as a member of the victorious United States rowing team, he was awarded a gold medal at the Olympic Games. He was trained as a surgeon at the Cleveland Clinic and at St. George’s Hospital in London. In 1968, as an Army surgeon in Vietnam, he was awarded the Bronze Star.

Dr. Esselstyn has been associated with the Cleveland Clinic since 1968. During that time, he has served as President of the Staff and as a member of the Board of Governors. He chaired the Clinic’s Breast Cancer Task Force and headed its Section of Thyroid and Parathyroid Surgery. He is a Fellow of the American College of Cardiology.

In 1991, Dr. Esselstyn served as President of the American Association of Endocrine Surgeons, That same year he organized the first National Conference on the Elimination of Coronary Artery Disease, which was held in Tucson, Arizona. In 1997, he chaired a follow-up conference, the Summit on Cholesterol and Coronary Disease, which brought together more than 500 physicians and health-care workers in Lake Buena Vista, Florida. In April, 2005, Dr. Esselstyn became the first recipient of the Benjamin Spock Award for Compassion in Medicine. He received the Distinguished Alumnus Award from the Cleveland Clinic Alumni Association in 2009. In September 2010, he received the Greater Cleveland Sports Hall of Fame Award. Dr. Esselstyn received the 2013 Deerfield Academy Alumni Association Heritage Award In Recognition of Outstanding Achievement & Service, and the 2013 Yale University George H.W. Bush ’48 Lifetime of Leadership Award. Dr. Esselstyn has also received the 2015 Plantrician Project Luminary Award, the Case Western Reserve University School of Medicine 2016 Distinguished Alumni Award, and the American College of Lifestyle Medicine 2016 Lifetime Achievement Award.

His scientific publications number over 150, “The Best Doctors in America” 1994-1995 published by Woodward and White cites Dr. Esselstyn’s surgical expertise in the categories of endocrine and breast disease. In 1995 he published his bench mark long-term nutritional research arresting and reversing coronary artery disease in severely ill patients. That same study was updated at 12 years and reviewed beyond twenty years in his book, Prevent and Reverse Heart Disease, making it one of the longest longitudinal studies of its type. In July of 2014 he reported the experience of 198 participants seriously ill with cardiovascular disease. During 3.7 years of follow up of the 89% adherent to the program, 99.4% avoided further major cardiac events.

Here is the interview that Varvara Tsepkova and I conducted with Dr. Esselstyn recently:

A: Cardiovascular disease or coronary artery heart disease is nothing more than a toothless paper tiger that need never ever exist. And if it does exist it need never ever progress. We have taken this concept and turned it into a billion dollar industry for an illness that does not even exist for half the planet. For instance, how often do you think the Okinawans [Side note from Ben: Check out the Ted talk video “How to live to be 100+” by Dan Buettner] and the rural Chinese and those in central Africa have their cholesterol checked? Not very often. So Cholesterol checking can be very misleading. Someone can get their cholesterol checked and if they are taking a heavy dose of a statin drug, their cholesterol may look very attractive to them, even though they are still eating the terrible western diet, which guarantees that their diseases is going to progress.

Q: So what healthy cholesterol level should we thrive for?

A: Maybe about 10 or 12 years ago, I would have said that cholesterol is THE key factor. I no longer feel that way. Since we were infants we’ve had Cholesterol coursing through our bloodstream. It is essential. Every single cell in our body has a membrane that is made of cholesterol. It’s the base line for all our sex hormones. No number has ever caused heart disease. What causes heart disease is what is passing through our lips every day and is going to injure the life jacket and the guardian of our blood vessels which happens to be that delicate inner most lining called the endothelium. The endothelium manufactures a truly magic molecule of gas called nitric oxide. And nitric oxide has a number of remarkable functions which are responsible for maintaining the salvation of the health of our blood vessels:

Number 1, Nitric oxide keeps all the cellular elements within our blood stream flowing smoothly like teflon rather than velcro and it keeps things from getting sticky.

Number 2, Nitric oxide is the strongest blood vessel dilator in the body. When you climb stairs, the arteries to your heart, the arteries to your legs, they widen, they dilate.

Number 3: Nitric oxide prevents the wall of the arteries from becoming thickened, stiff or inflamed, and protects us from high blood pressure.

Number 4: And this is absolutely the key: A healthy, normal amount of nitric oxide protects us from ever developing blockages or plaque. So literally, everybody on the planet who has cardiovascular disease has their disease because they have so sufficiently trashed and injured their delicate endothelial capacity to make nitric oxide and don’t have enough left to protect themselves from developing cardiovascular disease.

Q: As a large number of the US population is taking cholesterol lowering drugs, can one get off those drugs by switching to a plant based diet? If so, how long does it take?

A: How long would it take? There are many who are unable to take a cholesterol lowering drug who will not be precluded from enjoying full benefits of plant based nutrition.

Q: What does the ideal plant based diet look like in your opinion?

A: There is a tremendous variety in plant based foods. When you look on one end of the spectrum, you look at the Tarahumara Indians in Mexico, who never have heart disease. They live only on the 3 sisters: beans, corn and squash with no nutritional deficits. And there is no obesity, there is no hypertension, and they are very energetic and very athletic. Then you have places in Okinawa, where there will be more emphasis on potatoes. It’s interesting, everybody thinks the Okinawans are thriving on fish, but in truth their main staples are potatoes and vegetables. To me, the foundation of healthy whole food plant based nutrition includes all the various whole grains for cereals, bread, pasta, rolls, 101 different types of legumes, beans, lentils, sweet and white potatoes, the rainbow of vegetables: red, yellow and especially green leafy vegetables and some fruit. And you can’t overemphasize the importance of chewing the green leafy vegetables; I think that’s very important.

Q: What’s your take on fats?

A: Let’s look at the foods that injure the endothelium every time they pass our lips. Those foods are oils: olive oil, corn oil, soybean oil, safflower oil, sunflower oil, coconut oil, palm oil, oil in a cracker, oil on a piece of bread, oil in a salad dressing. Oil injures the capacity of the endothelium to make nitric oxide, as does anything with a mother or a face: meat, fish, chicken, fowl, turkey and anything that is dairy: milk, cream, butter, cheese, ice-cream, yoghurt and any excesses of sugary foods: cake, pies, cookies, stevia, agave, maple syrup, molasses and honey. I have no problem for people that do not already have heart disease to have nuts and avocado. However, once somebody has established heart disease, I like to really restrict them from nuts and avocado. There’s just too much likelihood of an excess of saturated fat. And besides, nuts are highly addicting. How many people do you know who will eat one nut? For those patients with heart disease nuts would be in the glove compartment, in the bathroom, the hallway the kitchen, the dining room, the work space, so most patients with heart disease I prefer them to avoid nuts.

If we go back to 1970’s and 80’s when researchers and investigators were trying to establish cardiovascular disease in rodents and rabbits, what did they feed them? Peanut oil.

Q: So for those people that consume fat to improve brain functions, are they opening themselves up to cardiovascular disease down the road?

A: The essential fatty acids are Omega 6’s and Omega 3’s. I don’t know if I have heard of anybody who walked into an emergency room and said, “My god help me out, I’m deficient in Omega 3’s.” What you can do to be sure you have sufficient fatty acids? You will never be deficient in Omega 6’s here in the west. As far as Omega 3’s, I have no problem, even with patients with heart disease, having a tablespoon of ground flax seed or chia seeds on their cereal. In addition they’ll get plenty of Omega 3’s from eating green leafy vegetables. I don’t see any point in trying to add bacon fat to improve your brain function. That’s a real stretch.

Q: What about the word ‘vegan’, we’ve heard that you do not use that term in your books or anywhere else. Why not?

A: When I hear the word ‘vegan’ i get a little nervous. I don’t use the term ‘vegetarian’ or ‘vegan’ in my book anywhere, because I treat vegans for heart disease. Why? Because vegans eat oil. Vegans eat French fries. Vegans eat glazed donuts. They put themselves at risk for heart disease when they eat all that oil. Also, when you go into a supermarked to the produce section and you pick up something like bok choy, Swiss chard, kale, collard greens, beets, there is never any label. You don’t have to read about any ingredients. If you’re eating out of a box, a bag or a can, now you’ve really got to be careful.

Q: Currently there are a lot of discussions around ‘fasting’. How helpful is fasting for disease prevention?

A: I think there is a real place for supervised fasting that is water only. When it’s done under medical supervision with people who know how to do this, I’ve seen it to be extremely effective with patients that have diabetes, hypertension and obviously those who are carrying extra weight. I think that whole field of fasting has something significant to offer, but I’d like to see it done in a climate where it can be properly supervised and the data collection can be quite accurate, so that the results obtained are not just anecdotal or hype or snake oil, but are based on rock solid science.

Q: Do you see a need for folks that are already on a whole food plant based no junk food diet to ‘fast’?

A: I think if somebody’s eating whole foods plant based nutrition, the need for them to have to fast is rather unlikely, because they are not going to have high blood pressure, they are not going to be diabetic and they are not going to carry around extra weight.

Q: What’s your take on alcohol consumption? Yes, no? In moderation?

A: Alcohol is interesting. I think that if you use the term ‘moderation’, from 1000 people you are going to get a 1000 different answers. Moderation to somebody who is drinking 6 cans of beer a night, might be to cut it down to 3. Alcohol is a toxin, it’s toxic to the brain. It’s toxic to the liver and it’s also toxic to the heart. It’s especially a problem for the heart for those who have a tendency for Atrial Fibrillation, There is good science to show that somebody who has Atrial Fibrillation certainly should not be having alcohol, because it makes it very hard to get rid of that bothersome Cardiac Arrhythmia. Now, what are we left with them? I think it’s fine if people want to have a beer on a Friday or Saturday night or a drink of wine. Earlier there was some data that suggested that people who drink have less cardiovascular disease. I think that has really been found to be an extremely flawed study. And to take a more realistic look at it, moderation would be one drink on the weekends, but to go beyond that and put a toxin into your body everyday, that has an adverse effect on your Biological system, like your heart, brain and liver, is probably inappropriate.

Q: So that same concept of moderation also applies to diet, is there such a thing as eating a steak, a burger, a hot dog or some other animal product every so often?

A: Here we have a situation where now we know that in the west when we do autopsy studies of women and men between the ages of 17 and 34, who have died of accidents, homicides and suicides, we now find that the disease is ubiquitous. Not enough for a cardiac event, but here we have cases where young people have already established cardiovascular disease which really is not going to create cardiac events until those people are in their late 40’s, 50’s, 60’s and so forth, so the idea that somebody eats well all week long and they have burgers, cheeseburgers and milk shakes on the weekend is just not good. If you add that up: a weekend is two days, that’s 104 days out of 365 that you are absolutely trashing and injuring the capacity of your endothelial cells to make nitric oxide, which is the great salvation of your cardiovascular system. Eating badly for 104 days out of every year, after 20 or 30 years that’s going to build up. Maybe they’re not having a heart attack, maybe it’ll be more subtle. Maybe it’ll be a stroke, maybe it’ll be more subtle: it could be dementia that occurs when you’re in your 80’s and 90’s. Because all those small vessels in the brain have now become diseased enough that tiny strokes have accumulated and now you have dementia. You don’t suddenly wake up on your 85th birthday with dementia. You work hard in all those preceding decades to establish the foundation for that kind of deficit.

Q: What’s your take on superfoods imported from far away countries?

A: If somebody makes a claim that a food is a ‘super food’, what you have to look for is peer reviewed scientific research that is done responsibly, accurately and with integrity. And that’s quite different than just marketing.

Q: Do you consume any superfoods or supplements yourself?

A: No, the only supplement that I’m taking is B12.

Q: How much B12 do you recommend to take?

A: By age 60 our B12 experts would suggest 500 mcg daily and over 70 1000 mcg daily. Why? You’re unlikely to get too much. But what seems to happen is as people become more senior, there are 2 vital ingredients in our stomach that are essential for the absorption of Vitamin B12 and those are the Intrinsic factor and gastric acid, and those tend to be less as we become more senior. Which is why the recommendation for folks over 70 is 1000 mcg/daily. Those are the recommendations of Dr. Don Jacobson who was an international scholar on B12.

Q: Do you think people should be watching their blood markers as closely as they are watching their weight to be aware of their health status?

A: You can check to see if you have inflammation from the inside of the arteries from a test called the HsCRP, highly sensitive C-Reactive Protein (CRP). Highly sensitive C-Reactive Protein would be very helpful. Because it tells whether someone is eating carelessly enough that perhaps the degree of inflammation puts them at a significant risk. Anything over 2 would be significant risk. Between 1 and 2 would be a moderate risk and below 1 a very minimal risk.

Q: So as we are starting 2017, how do you see this movement going forward? And has it made some good improvements over the last decade? And where do you see the movement going?

A: I think the movement is so different now in the climate of acceptance than it was 30 years ago. What will move this forward is not hype, not snake oil, it’s going to be the hard science. The seismic revolution of health is not going to come about through the invention of another pill, procedure or an operation. This revolution will come about when the medical community has the will and the grit and the determination to share with the public truly what is the lifestyle, and more specifically, the nutritional literacy that will empower them to eliminate 75% to 80% of chronic illness. Whole food plant based nutrition does not only get rid of heart disease, it gets rid of strokes, vascular dementia, hypertension, diabetes, Crohn’s disease, even ulcerative colitis Rheumatoid arthritis, Lupus, multiple sclerosis, asthma, allergies and the list goes on. It’s absolutely the most exciting thing you can imagine ,because there is no additional expense, there is no horrible drug that is ridiculously expensive with some inescapable side effect. It’s simply the strongest tool that medicine has had in its toolbox .

Q: Any parting comments?

A: I’m very pleased and delighted to be part of this and I want to share one additional thing: It was just last summer that I was asked by the American College of Cardiology to become a member of their Nutrition Committee. To me that is such an exciting step forward to think that the cardiologist themselves who have for the longest time been rather hesitant to accept this, are now becoming so aware of the data that they themselves want to have education in this regard, so they can offer information to their patients that has something to do with the causation of the illness. You see, since the days of Hippocrates, there’s been a basic covenant of trust, between the caregiver and the patient, that wherever possible the caregiver will share with the patient what is the causation of the illness. And sadly today in cardiovascular medicine that’s not happening. And it’s not happening out of a sense of their being mean, it’s happening because neither in medical school nor in their postgraduate training do the cardiologist ever get exposure to nutrition education.